Provider Demographics
NPI:1659485910
Name:GOLOMB, JOLIE (LCSW,LICSW)
Entity Type:Individual
Prefix:MS
First Name:JOLIE
Middle Name:
Last Name:GOLOMB
Suffix:
Gender:F
Credentials:LCSW,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5129 SCARSDALE RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-2320
Mailing Address - Country:US
Mailing Address - Phone:301-320-3719
Mailing Address - Fax:301-565-2998
Practice Address - Street 1:4405 E WEST HWY
Practice Address - Street 2:SUITE 506
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4522
Practice Address - Country:US
Practice Address - Phone:301-961-9220
Practice Address - Fax:301-656-2998
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2010-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3029371041C0700X
MD092771041C0700X
NYRO30051-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD840581600Medicaid